Renal artery stent infection and pseudoaneurysm management.
Ann Vasc Surg
; 24(1): 114.e13-7, 2010 Jan.
Article
em En
| MEDLINE
| ID: mdl-19748220
ABSTRACT
BACKGROUND:
Infection of a renal artery stent and pseudoaneurysm is extremely uncommon, with four reports in the literature. We present a fifth case and the complex management resulting in kidney salvage. METHODS ANDRESULTS:
A 56-year-old female underwent right renal artery stenting for hypertension. Postoperatively, she developed methicillin-resistant Staphylococcus infection, treated with antibiotics. Eight-month follow-up duplex ultrasound revealed a right renal artery pseudoaneurysm just distal to the stent. Computed tomography angiography (CTA) showed 2.8 cm proximal and 4.2 cm distal mycotic aneurysms. Antibiotics and planning angiogram were prescribed. A Chevron incision and duodenal kocherization were employed. The aorta below the superior mesenteric artery and below the renal vein was mobilized, as were the right renal artery and vein, hepatic artery, and saphenous vein. Following heparinization, the aorta was cross-clamped, as was the right renal artery at the hilum. The kidney was infused with cold saline. The renal artery stent was explanted, and aneurysmectomy was performed. The renal artery ostium was oversewn. A renal artery to hepatic artery saphenous vein bypass was fashioned, and patency was confirmed with intraoperative duplex ultrasound. Postoperatively, creatinine was normal, renal scan showed the right kidney to be functional, and duplex ultrasound showed a patent bypass graft. The patient was discharged on postoperative day 11 on long-term antibiotics. Eight-month follow-up duplex and CTA showed a patent bypass and durable repair.CONCLUSION:
Renal artery stent infection with pseudoaneurysm is rare and can be diagnosed with duplex ultrasound. Renal salvage can be obtained but requires stent removal and autologous bypass grafting.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Artéria Renal
/
Veia Safena
/
Aneurisma Infectado
/
Stents
/
Infecções Relacionadas à Prótese
/
Falso Aneurisma
/
Remoção de Dispositivo
/
Hipertensão Renovascular
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
Limite:
Female
/
Humans
/
Middle aged
Idioma:
En
Ano de publicação:
2010
Tipo de documento:
Article